Approach to Chronic Kidney Disease

Question 1

Chronic kidney disease (CKD) is an abnormality of kidney __ or __, present for > __months.

Answer 1

Chronic kidney disease (CKD) is an abnormality of kidney structure or function, present for > 3 months.

Question 2

GFR criteria for CKD

Answer 2

GFR <60 ml/min/1.73m^2

Question 3

GFR is used to quantify kidney function because of 3 reasons

Answer 3

1. it is a marker of excretory function
2. it is correlated with widespread damage to the kidneys
3. it is associated with progressive complications of kideny disease

Question 4

Glomerular filtration rate (GFR) definition: Rate that fluid is filtered across the __ ___ __ into the __ __

Answer 4

Rate that fluid is filtered across the
glomerular basement membrane into the renal tubules

Question 5

there are many equations to solve GFR, but all need to be relative to ___ ____ ___ due to the difference in kidney size

Answer 5

all must account to body surface area

Question 6

the gold standard of measuring GFR is measuring ___ clearance, but it is impracticeal because:

instead, we estimate GFR using ____. We must take into acount the age, ___ and ___ of the patient.

Answer 6

the gold standard of measuring GFR is measuring INULIN clearance, but it is impracticeal because: YOU NEED A CONSTANT INULIN INFUSION, MULTIPLE BLOOD AND URINE SAMPLES, AND REGRESSION ANALYSIS

instead, we estimate GFR using CREATININE. We must take into acount the age, SEX and ETHNICITY of the patient.

Question 7

GFR equation more accurate in younger patients and those with higher BMI and lower levels of kidney fucntion

Answer 7

the CKD-EPI

Question 8

factors that increase plasma creatinine (5) and lead you to underestimate creatinine levels /gfr

Answer 8

1. high muscle mass
2. ingestion of cooked meat
3. creatine supplements
4. race, ethnicity– african americans
5. reduction of gut creatininases.

Question 9

factors tha reduce creatinine secretion

Answer 9

medicaations like trimethorpim, cimetiidine, fenofibrate.

Question 10

factors that reduce plasma creatinine

Answer 10

small muscle mass

amputation

muscle wasting disease

dialysis

• these will all tend that you overestimate GFR

Question 11

the rock:

Answer 11

Question 12

this athlete with no limbs:

Answer 12

Question 13

Usually, the definition of CKD is having a GFR <60 ml/min/1.73m2. what if the CFR is more than that?

Answer 13

CKD may present as >60 ml/min AND evidence of kidney damage either through abnormal urinalysis of imaging

Question 14

things in urine sediment that might indicate kidney structure abnormalities

Answer 14

1. proteinuria. albuminuria >30mg/day or ACR >3. Can also be non-albuminuria
2. dysmorphic hematuria or RBC casts
3. WBC casts
4. granular casts or renal tubular epithelial cells

Question 15

urine electrolyte issues that might indicate CKD

Answer 15

urine electrolyte wasting

Question 16

urine concentration that may indicate CKD

Answer 16

urine concentrating defects; ex/ constantly dilute despite dehydration.

Question 17

t/f: a lower gfr is associated with an increased risk of death, CVD mortality, and hospitalization.

Answer 17

true

Question 18

global prevalence of CKD is ___

Answer 18

9.7%. it’s the 10th leading cause of death worldwide

Question 19

t/f CKD accounts for a significant amount of CVD mortality

Answer 19

true. it accounts for 7.6% of CVD deaths.

Question 20

t/f the mortality for age-standardized CKD cases is decreased

Answer 20

false.While the age standardized mortality associated with cardiovascular
disease, cancer and COPD has decreased, this has not been seen with
CKD

Question 21

most common causes of CKD world wide

Answer 21

1. diabetes
2. hypertension
3. glomerulinephritis

Question 22

CKD is classified by the CGA staging. outline the 3 standings of CGA

Answer 22

1. cause
2. GFR
3. Albumin.

Question 23

65y M with kidney biopsy that indicated ANCA-associated vasculitis with a GFR of 27 ml/min/1.73m2 and ACR of 25 mg/mmol and biopsy proven ANCA- associated vasculitis.

What is the stage pf CKD?

Answer 23

• = Stage G4 A2 CKD secondary to ANCA associated vasculitis

Question 24

More severe stages of CKD are
associated with a higher risk of
progression to __

Answer 24

More severe stages of CKD are
associated with a higher risk of
progression to ESKD- end stage

Question 25

risk progressioni to the ESKD can be quantified with:

Answer 25

kidney dailure risk equation.

Question 26

Note

Question 27

history questions to evaluate CKD

Answer 27

determine the underlying cause

Question 28

physical exam method to use to evaluate CKD

Answer 28

Question 29

lab investigations when evaluating CKD

Answer 29

Question 30

Please identify the stage of CKD for the individuals listed below.

Answer 30

Question 31

frothing of urine indicates ___

Answer 31

proteinuria